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HomeMy WebLinkAbout032-2041-90-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSM# LOT SECTION- Ll N-R~W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTE i a i INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ► t BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION .~X S~N~ Manufacturer: Liquid Capacity: Setback from: Well House 7 Other Pump: Manufacturer. Model#h Size Float seperation- Gallons/cycle: Alarm Location z t° SOIL ABSORPTION SYSTEM Width: ,42_ Length Number of trenches Distance & Direction to nearest prop, line: / Setback from: well: House_ Others ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet r PC bottom-,Y-T; Pump Off Header/Manifold Bottom of system_ /Z/ Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: /OA;1 e6~ 3/93:jt ST. CROIX COUNTY ZONING OFFICE, CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the residence located at: szJ 1/4, &A) 1/4, Sec. _N, R_Z~51_W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No cif no, skip-- next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete- Steel Other Manufacurer (if known): Age o T nk (if own): (Signature) (Name) Please Print All° 5i sue/ (Title) (License Number) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the est of my knowledge will conform to the requirements of ILHR-83, W. Adm. Code (except for inspection opening over outlet baffle). Name Signatur MP/MPRS X75-9 5/88 WisconsinDe~artmentofIndustry, PRIVATE SEWAGE SYSTEM County: Labor ardHuildi+lFelaons INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 299093 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: MARTY, JIM SOMERSET CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: r /00r~ 032-2041-90-000 TANK INFORMATION LEVATION DATA 970,1413 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark loo-e-6 /DO Dosing Aeration Bldg. Sewer - ~ - Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet p ys' TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake 7 3 S Septic y~ Jr' c NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe X 39'' /,6( Holding Bot. System go,Sg PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Lrictio System TDH Ft oss Head Forcemai n Len Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width ^ Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS 111 I'll DIMENSIONS LEACHING Manufacturer. SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM INFORMATION Type O CHAMBER Model Number: System: rD 30 9Q / OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges a0-V/y/ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 11.30.19.636F,SW,NW 709 68TH STREET O l Plan revision required? ❑ Yes ET No Use other side for additional information. SBD-6710 (R 05/91) Date Inspe is Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: RpEw Safety and Buildings Division ~~i~'■•i i SANITARY PERMIT APPLICATION Bureau of Building Water System: 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitar Permit Number a go93 The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. /p n~ State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prope X Owner me P operty Location kft/a 1/4, S T , N, R 400# Property Owner's Ma~ffig Address . Lot Number Block Numbe 7"14 Zc~ V, City, State Zip Cod Phone Number Subdivision Name or C_SM N ,m er ( /Jr IL TYPE F BUILDING: (check one) ❑ State Owned ❑ it Nearest Road ❑ VII (age t~ Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo O~ 30. &31o F 03~ 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ® Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 JRJ"Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. ate 6_ System Elev. 7. Final Grade Required (sq. ft.) Propose (sq. ft.) (Gals/day/sq. ft.) (Min./i ch) Elevation Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel New Existing strutted glass App. Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber VI11. RESPONSIBILITY STATEMENT I, th undersigned, as me responsibility for in allation of th~ionsite sewage system shown on the attached plans. Plu e ' Nam (Plumb 's Si at e- mp MP/MPRSW No.: Business Phone Number: Plumber's dres ree City, Stat ip Code): IX. COUNTY /DEPART ENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge fee) I Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 76398 (R. 05194) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' x i c 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration-date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems-must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever, necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line 13 if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE ` 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. 91 r i I t , I i -f0, \p\ 8~ zo, t n f ~ f i - i I I ~ f ~ j ~ ~ ~ 11 ~ ~ i - .1- --Y i I~' fi ~ r~ ~ I 1~ 1 I ~I I ~ I I r I~ f 1 j!~ -I i ~ ~ I I 1 , i! I I-~ i i { , , i ~ I ~ i I ~ • ~ I f I I I C r ~ - ~ ~ ! ~ + ~ i ~ l { ~ ~ ~ 1 _ i i j I~ ii t- _ t + r i t ~ I _ _ . 1 1 ~ ~ r i i I ~ I ~ ; - i , _i ~ j j i I i j f _ I- - ~ ~ ~ c I i I ! I} I ~ j i j i I i f f± I`~ i~ ' i i i I I I I I I i ~ t i i ~ I t C ~ r~, I j j 1, , I G ~ , I i i i I I__ - t_ ~1 ~ _ ~ 1 j; ~ i 1{ I I~ ; ~ ~ j 1 ~ ! ~ ~ 1 ~ r j ~ I ; ; ; I~~ i i ~ 1~~ ~ f f- ~ I I I I I I I ~ { i e j ~ i i t 1- 4 I i { I { 1 ~ r~ } -t 1---- I - ti{ t 1 Ii ~L j . ~ ~ i ~ l t i l I I I I ~ l l t I f fi, II 1 ~ i i I I A l i _ j I I ~ i { j f f ! ~ ! I ~ j_ I j I ~ ' ~ I 1 i { i ~ ~ ! ~ I ' ~ ~ I i I i f ` 1 ~ ~ t f 1 ~ f t j } i 1 t { } j ; i ~ i t ; ~ t I I ~ I i i ~ j- 1- i ' i i ~ j j i ~ 1 - ! r t ~ t ~ = ! , ~ I t I ~ , i i I i i ~ ~ I ~ ~ i i j I , I I ~ ~ ~ ; ~ ! I ~ i ~ i I i~ i~ I i ; _ I 1 , t i ~ I I i PAGE OF i PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VE NT CAP 4 VENT PIPE WEATHERPROOF APPROVED LOCKING JUAICTIOM BOX MANHOLE COVER W ITN . ~ 25' FROM DOOR, WINDOW OR FRESH WARNING L118EL 12'MIU. AIR INTAKE I GRADE I H" MIN. I Mlu. COWDUIT IB"M IM. IAJLET PROVIDE ( AIRTIGHT SEAL I i i I I I APPROVED JOINT A I III APPROVED JOINTS W/ PIPE I III W/" PIPE EXTENDING 3' I II ALARM EXTENDING 3' OWTO SOLID SOIL I II ONTO SOLID SOIL I I I I ON C I I LLEV. FT. PUMP OFF 0 CONCRETE BLOCK RISER EXIT PCRMITFED OIJLy IF TAIJK MANUFACTURER HAS SUCH APPROVAL 3" I4PPROVEN BECDING undcr TJ4►sK SEPTIC E SPEC.IFI'CATIOUS DOSE TANKS MANUFACTURER: tI L-7Z.9e IJUMBER OF DOSES: PER DAM TA UK SIZE: 7LLOIIJS DOSE VOLUME ALARM MANUFACTURER: INCLUDING BACKFLOW: GALLONS MODEL UUMBER: ZallQ CAPACITIES: A=~?gIIJCHES OR GALLONS SWITCH TYPE: J B =r-- -2 INCHES OR 1GL_ GALLONS PUMP MAIUFACTURER: C= INCHES OR GALLONS MODEL NUMBER: Da INCHES OR GALLONS SWITCH TYPE: - L MOTE: PUMP AWD ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM INSTALLED OU SEPARATE CIRCUITS VERTICAL DIFFERENCE OETWEEW PUMP OFF AND DISTRIBUTION PIPE.. FEET + MINIMUM METWORK SUPPLY PRESSURE. . . . . . . . . . . FEET FEET OF FORCE MAIM X F/o. rT.FRICTIO►J FAC 01k.. FEET TOTAL DyWAMIC HEAD = FEET 11JTERUAL. DIMEWS 0►J9 OF T K: LEN~TM ;WIDTH ;LIQUID DEPTH SIGIJED. LICENSE NUMBER: SATE: Pe ormance Submersible Effluent Curves PUMP%-N) METERS FEET 90 MODEL 3885 25 60 SIZE 3/4" Solids WE16H 70 20 WE10H j ~ , 110- -WE07H 15 50 W EOSH 40 10 . WE03M 30 T__t WE03L S 10 0 0 0 10 20 30 40 50 60 70 60 90 100 110 120 GPM 0 10 20 30 RP/h CAPACITY C0 GOU LDS PUMPS, INC. SB*CA FADS NEW VCQK .3wi- METERS FEET 120 MODEL 3885 35 SIZE 3/a" Solids 110 WE15HH 100 30 90 25- w 70 20 60 50 WEOSHH 15 40 10 30 20 S 10 0 or-T-1 I I H 0 10 20 30 40 50 •60 70 80 90 100 110 120 GPM 0 10 20 30 mf1h CAPACITY eim Goulds Pumps, Inc. EIIpoypmy, 1qu C38A, WiscorisinDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT Page'/ of2- Labor and Human 'Relations. Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than • ches in size. Plan must include, but not limited to vertical and horizontal referen i t%M , direc i and % of slope, scale or PARC L L . # dimensioned, north arrow, and location asft& ce to nearest4o APPLICANT INFORMATION-PL RIf~1f OR a ON REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION L GOVT. LOT 1/4 1/4,S T N,R (or PROPERTY OWN R':S IL KG ADDRE Sl GJi0!". LOT # BLOC # SUBD. NAME OR CSM # COUNTY STATE ZIP R r' ❑CITY ❑ LAGE OWN NEAREST RQPrD s` .6eZ,.-t 14 [ ]New Construction Use JA Residential / edrooms [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate -,-Z--bed, gpd/ft2_~trench, gpd/ft2 Absorption area required 1. "f bed, ft2 , trench, ft2 Maximum design loading rate bed, gpd/0_.,~trench, gpd/ft2 Recommended infiltration surface elevation(s) 22 ft (as referred to site plan benchmark) Additional design / site considerations Parent material - Flood plain elevation, if applicable gla= ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL 7HOLDING TANK U=Unsuitable fors stem -US ❑U 11 EIS ❑U ®S ❑U ®S ❑U ❑S OU ❑S RU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roo GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trertch _4Z Z Ground elev. Q ft. Depth to limiting factor Remarks: Boring # O ` c /J f Ground elev. 99 Depth to limiting factor Remarks: CST Name:-Please Print ✓ j Phone: i - L291 2- Address: Signature: Date: CST Numbe : . ~1~ 174 PROPERTY OWNER SOIL DESCRIPTION REPORT Pa de of PARCEL I.D. # Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Baxxiary Roots Bed Trench \M1 h•.\ tv /I J2, 7 -AL Ground _ elev. ft. Depth to limiting factor Remarks: Boring # F: < Ground elev. ft. Depth to limiting factor F-F Remarks: Boring # Ground elev. n. Depth to limiting factor Remarks: Boring # x\Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) J, S'~,/mss a2~~o1 ~~S T.L t` SrJs/pa-. 1 b ~ I 81 r-i / :3a" i \ \ C. S. M. L_ 10, PG. 858 a 5 1 635 C a \ s S°v 636 G 0 498.10'. M I 807.08, Alld/ 636 C -r - IV ry 1.4, -r / 636 E 68tH 0 636 D 636 H M 120.05' 365' 315' _ 634,4C_ _ WI . \ZW SEC. • Y ~ ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the - .I,n, ,Z64 residence located at: 1/4,11 Y A) 1/4, Sec. T_Er N, R~W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last-time serviced Did flow back occur from absorption system? Yes No X (if no, skip next line) Approximate vlume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacu r (if known): Age of an ifi n wn)• (Sign tur (N6 e) ase Print --Aqal's-~, j s2S-9 (Title) (License Number) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform t the requirements of ILHR-83, is. Adm. Code (except for inspectio op ping ver outlet baffle). Name Signature MP/MPRS_ 5/88 I This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. owner of property - -1..,s K Mo,'?d- 0 Location of property 1/4 1/4, Section I T 36 N-R_c W Township ~Of►'ters ~ Mailing address_ -09 CogThg~k_ Address of site ov-._~ as o~nnba ~Z- Subdivision name Lot no. Other homes on property? Yes V-*~No Previous owner of property Lku C.V'vr1Ic, Total size of property `fa a Ac- v--c' s Total size of parcel Date parcel was created Are all corners and lot lines identifiable? _Yes No Is this property being developed for (spec house) ? _Yes No Volume Y109 and Page Number o2 9 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMDL•'R, VOLUME: AND PAGE NUMI3ER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the dead description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Decds as Document No. y609~3 and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Decd:, a:; Document No. c . IC_ -ure of App Ica Co-Applicant: Ucitc f Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~o Vyye-s yO~~ MAILING ADDRESS Q ~g Oe rs~ . S15 PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE f~Otn \-(fCSlt-- PROPERTY LOCATION i~ 1/4,~ 1/4, Section 11 TD N-R_W TOWN OF ST. CROIX COUNTY, WI YJiJICA. SUBDIVISION LOT NUMBER CERTIFIEDSURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July I, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. UWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returne to the St. Croix County Zoning Officer within 30 days of the three year cx sir Lie. SIGNED. DATE: / St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 . o b¢,. ~ '3s`x~. van:-*F'=,~,~;:.;v. ..•~:.=,4s. ~v ia.:.ea.?5~~5" . ;=i~' ~A "u,.d. r.,s,~'.'~- zs'-Ta~"hR IS tOCUMENT NO. THIS f•,<A 043VAV90 FOR ateaact#q Sava &MAM DEM t STATE BAS OF WISCONSIN TOMM $-1 460993 ST. CROIX me W1 Libby...Ar..Baillarq o~?x .._alk/a R*edf(WR + Libby ......Dec?ieine,~ a single person.......... AUG 1 10: 30 M } Conveys and warrants to ...!1~.5''.P...~_e_ MBXty ..?.r_..... Baillargoon,._.huaband..an-d,..w.i.fe.--as.. oint-_-tezaAtss, ` I _ - + ,KTU YW37r*of Stw"w 194 GT@eW Subs #209 • - ` 3t Croac - ° the following described teat estate In .......................County, - State of Wisconsin: Tax Paraet No r Part of the SW 1/4 of NW 1/4 of Section 11, Township 30 North, Range 19 West, St. Croix County, Wisconsin; described as follows: Commencing on the West quarter corner of said Section 11; thence N88058'15"E on the South line of said NW 1/4, 365.0 feet to the point of beginning; thence N16°06'40"W 599.33 feet; thence NEly on a 967.22 foot radius } curve, concave Nally, chord bearing N68°30'E 181.77 feet; thence NEly on a 256.0 foot radius curve, concave NWly chord bearing N56°10'E 62.0 feet; thence S21°13'E 720.09 feet; thence S88°58'15"W on South t line of said SW 1/4 of NW 1/4 315.0 feet to the point of beginning. 1 ®d o s.~ 11 This is----.---•-.--- homestead property. (is)~ Exception to warranties: Dated this 31 July 90 day of - 19- E • i1 I} ---------(SEAL). fo?~(SEAL) I I' L'bb Baillargeon, /k/a (SEAL) -Libby .A.--Dec-heirie.-_ - Z - - - - (SEAL) I II ;i ff AUTHUNTICATION ACKNO vi1LNDGMENT I 1 ~ Signature(s) STATE OF'tom--V4inne:.o Washington ! Ccunty. i authenticated this .--.°--day of--------------------------- 19 Personally came before me this 3Z--..-----day of ~iy--•--•------------------ 19---9~- the above nam-A Libb A Baillar eon aka Libb A -•------••--•-y----'----------- .I Deche ine , a single person „ I TITLE: MEMBER STATE BAR OF WISCONSIN - (11 not, authorized by 746.06, Wis. State) - • • - to me known to be the person who executed the foregoing instrument and acknowledge the same.